SERVICES

Arthritis
Children's Feet
Circulation Problems
Corns and Calluses
Diabetes and the Foot
Endoscopic Plantar Fasciotomy
Foot Surgery
Fungus and Nail Problems
Fungus Laser
Ganglion Cysts
Hammertoes
Heel Pain
Ingrown Toenails
Laser removal of warts & growths
Neuromas
Orthotics
Scar Reduction
Sports Injuries
Total Care for Ankle, Foot and Leg
Tumors
Warts and Growths
Wound care

Regular Foot Screening Is Essential For Healthy Diabetic Feet
This is an important fact for all people, but especially for people suffering from diabetes. Diabetic patients should take extra precautions when it comes to foot care because of the many foot complications associated with diabetes.

Because diabetic patients often have impaired circulation and limited sensation in their feet, areas of abnormal pressure can create open wounds on the bottom of the foot. These wounds, known as plantar ulcers, are slow to heal due to impaired circulation and are the leading cause of non-traumatic lower extremity amputations among diabetics.

All diabetic patients should seek a computerized gait and pressure analysis test to assess biomechanical foot function and identify areas of peak pressure. The Gait and Pressure Analysis Report generated by this test helps to identify those patients at risk for plantar ulcers and allows preventative measures to be implemented.

One key preventative measure is the use of foot orthotics. Orthotics are customized insoles worn in your shoes. They help to reduce peak pressure areas by distributing your weight evenly, thereby alleviating high pressure points on the bottom of the foot where ulcers may form.

The importance of proper foot care for diabetics cannot be stressed enough. Here are a few guidelines from the American Diabetes Association:

Check your feet and toes regularly for cuts, sores, bruises, bumps, blisters or infections.
Daily washing with warm water, never hot water, and good skin care are important.
Use moisturizing lotion regularly and wear thick, soft socks to protect your feet.
Avoid walking barefooted.

Heel Pain – Heel Spurs
The heel bone bears all of the body's weight with each step. The stress on it and its associated structures is tremendous. Painful heels and heel spur syndrome are usually secondary to biomechanical faults. (Biomechanics is the dynamic study of the changes that occur with weight-bearing or walking).

Biomechanical faults such as flexible flat feet, high arched foot deformities and tight Achilles tendons causes a great amount of stress on the plantar fascia (a long band of fibers that attach at the bottom of the heel bone and extend to the beginning of the toes to help create the arch of the foot). Other causes of stress on the heel and plantar fascia include recent gain in weight, high impact athletic activities, prolonged standing or walking.

Other causes of heel pain include plantar fasciitis (an inflammation of the plantar fascia), heel bursitis (an inflammation of a fluid filled sac at the attachment of the plantar fascia), and low back fractures or problems.

Your doctor will examine you and require appropriate tests including X-rays, and blood tests if needed. Heel spur syndrome may or may not show evidence on X-ray. Not all heel spurs hurt; it is the inflammation of the structures that cause the pain, and thus treatment is aimed at reducing stress on the foot and decreasing inflammation.

Treatment
Treatment for heel spur syndrome usually involves rest, a series of steroidal injections, anti-inflammatory oral medication, steroidal or non-steroidal, physical therapy, heel cups, and orthotics (an insert for the shoe to relieve stress on the plantar fascia and other biomechanical faults). Resistant heel spurs are treated surgically by removing the bony spur (a shelf of the bone that extends forward and horizontally from the heel bone where the plantar fascia attaches) and a release of the plantar fascia from its attachment on the heel bone.

Preoperative Considerations
Preoperative considerations are determined by your doctor and include your age, occupation, physical activities or requirements and general health status. Preoperatively, your doctor will explain the procedure to be performed, all risks and any complications that may occur.

The surgery can be performed in the office or at the hospital. You usually arrive for the surgery the same day and leave later that day when appropriate. The surgical procedures may require the use of a cast or a post-operative surgical shoe (a wide wooden shoe to accommodate bandages). Both serve to stabilize and protect the foot. Non-weight bearing on the operated foot may require the use of crutches or a walker. Limited use of the foot is usually permitted, with gradual return to activity in 4-6 weeks.

Post Operative Care
Care after the operation includes local care by your doctor, keeping the area and bandages dry, and elevation and ice to help reduce swelling if needed. Your doctor may prescribe medication for pain, to be taken if needed. Postoperative X-rays are usually taken.

A gradual return to a soft shoe is expected after 2 to 4 weeks. An orthotic is usually recommended to prevent recurrence of the problems.

Heel spurs extend across the width of the heel bone, and are removed completely when surgery is performed. X-rays are taken after surgery to confirm satisfactory surgical correction of this problem. The incision is usually made on the inner side of the heel of the foot.

Sometimes a drain is used immediately after surgery, and is removed before you leave the hospital. Appropriate medication for pain will be given to you to be taken if needed.

Your doctor may ask you to use crutches until he feels you are able to put full weight on your foot. Stitches are removed in 2 to 3 weeks.

As in all foot surgery, it is important that you follow your doctor's instructions carefully. Be sure to ask your doctor any questions you may have before or after surgery.

Conclusion
There may be additional methods of treatment for this common foot problem. Your doctor will discuss this with you. Each doctor develops a favorite treatment, and probably has the best percentage of results with that approach. Complete cooperation between you and your doctor is essential for a satisfactory result.

660 Glades Road, Suite 120 • Boca Raton, FL 33431 • (561) 368-3232